On July 15, CMS issued its proposed rule for its 2026 physician fee schedule, that included a 3.6% bump to physician payments.
The overall reimbursement for cardiovascular services is projected to increase by roughly 1% compared to 2025, according to a July 14 report by the American College of Cardiology. This projection includes changes to policies and individual service values, and the ACC notes that individuals and groups will be impacted differently, based on patient populations and services.
Here are five other notes on how CMS’ proposed rules for 2026 will impact cardiology:
1. The CMS Innovation Center is proposing a mandatory five-year ambulatory specialty model with the goal of holding specialists who have historically treated at least 20 original Medicare patients with heart failure. These specialists must also fall within selected “core-based” statistical areas or metropolitan divisions financially accountable for management of chronic conditions of congestive heart failure and low back pain. The model plans to reward specialists for effective disease management, meeting clinical guidelines and successful collaboration with other providers involved with their patients’ care. The proposed trial period of the model will run from performance period Jan. 1, 2027, through Dec. 31, 2031, and payment period from Jan. 1, 2029, through Dec. 31, 2033.
2. A proposed efficiency adjustment to the intraservice times and work relative value units of nearly all nontime-based codes in the physician fee schedule notes that there are efficiencies in performing medical services that accrue over time and are not captured in the normal process of developing RVUs. Using the Medicare economic index productivity adjustment for the last five years cumulatively applied, the rule proposed a 2.5% reduction to the intraservice time and work RVU of all nontime-based codes or codes that are otherwise excluded. The ACC will collaborate with the American Medical Association and other professional societies to address this “first-of-its-kind” proposal.
3. The proposed rule accepts the relative value scale update (RUC)-recommended value of 10.25 for left atrial appendage closure code 33340, despite efforts to delay revaluation of the code by the ACC. This proposed value represents a nearly 27% reduction from the current work RVU of 14. ACC said in the report that it tried to delay the revelation due to a restricted and flawed survey, and that it will “vigorously work to keep this reduction from being implemented.”
4. The code daily for percutaneous coronary interventions was revised and then resurveyed at the AMA RUC Committee in 2024 for implementation in 2026. CMS accepted the RUC-recommended values for all 12 codes, reducing several and increasing others. New codes were created for more complex stent cases and revascularization of a chronic total occlusion to allow for more accurate valuation.
5. The proposal included the addition of 276 procedures to the covered procedures list for ASCs, with a number of cardiovascular procedures being added to the list for final approval later this year.
